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PRIMED INSTRUMENTS INC.

Request for Distributorship / Representation

PriMed Instruments Inc. understands and appreciates the importance of our distributors and independent representatives and the role they play in the success of our organization.

Therefore we offer you the following:

  • excellent quality products and service
  • attractive discount / commission structure
  • exclusive territory
  • full marketing support

If your company wishes to join our dynamic team, please fill out and submit the form below:


Date:

Name & Title:

Name of Company:

Address:

Country:

Telephone:

Fax:

Email:

Web Site:

Branch Location:
Yes No

If "Yes", where:

Date business started:

Current number of employees:

What related product lines do you currently carry:

Number of Sales Representatives in your organization:

Are these representatives employees:
Yes No

Number of representatives who spend time in GI/Endoscopy Lab:

In what countries/states do you currently distribute:

What do you expect projected PriMed Instruments sales (USD) to be in:
First Year

Second Year

Consecutive Years